Naseem Zainab, Butt Qamar M, Shaukat Amina, Grenfell-Dexter Rachael, Zhu Junzhe, D'Souza Basil, Strugnell Neil
Department of Medicine and Health, University of Sydney, Sydney, Australia.
Department of Colorectal Surgery, Northern Hospital Epping, Epping, Australia.
Int J Telemed Appl. 2025 Jan 9;2025:9945160. doi: 10.1155/ijta/9945160. eCollection 2025.
Amidst the COVID-19 pandemic, telehealth (TH) has gained increasing relevance in colorectal patient care, prompting an audit of the TH clinic at a tertiary colorectal unit. This study evaluated telephone-based consultations' clinical efficacy and diagnostic thresholds for new lower gastrointestinal (LGI) bleeding referrals. We conducted a quality assurance audit of the per rectal (PR) bleeding TH clinic at Northern Hospital Victoria, evaluating new LGI bleeding referrals. Data from July 2021 to June 2023 were extracted from the Referral Management System (RMS) and analyzed. The study focused on newly referred patients, excluding those previously seen or awaiting procedures. Clinical efficacy was determined through sensitivity, specificity, and predictive values, with a receiver operating characteristic (ROC) curve assessing the TH method's discrimination threshold. Of the 239 patients, 131 met the inclusion criteria, with a compliance rate of 96%. The TH clinic demonstrated a sensitivity of 75.76% and specificity of 52.46% in distinguishing between colorectal and anal pathologies. The average time from referral to a diagnostic procedure was 9.75 weeks, with a reduction in median wait time for first appointments from 19 weeks prepandemic to 3.6 weeks. A cost-benefit analysis highlighted TH clinics' ability to reduce overhead costs and maintain a revenue stream despite reduced face-to-face consultations. Our study concludes that the telecare service model serves as an effective complementary approach for managing new LGI bleeding referrals. Further research on long-term outcomes and cost-effectiveness is necessary to fully assess telecare as a potentially sustainable hybrid model.
在新冠疫情期间，远程医疗（TH）在结直肠患者护理中的相关性日益增加，促使对一家三级结直肠科的远程医疗诊所进行了一次审核。本研究评估了基于电话咨询对新的下消化道（LGI）出血转诊患者的临床疗效和诊断阈值。我们对维多利亚州北部医院的直肠指检（PR）出血远程医疗诊所进行了质量保证审核，评估新的LGI出血转诊患者。从转诊管理系统（RMS）中提取并分析了2021年7月至2023年6月的数据。该研究聚焦于新转诊患者，排除那些之前已就诊或正在等待手术的患者。通过敏感性、特异性和预测值来确定临床疗效，采用受试者工作特征（ROC）曲线评估远程医疗方法的鉴别阈值。在239名患者中，131名符合纳入标准，依从率为96%。远程医疗诊所在区分结直肠和肛门病变方面的敏感性为75.76%，特异性为52.46%。从转诊到诊断程序的平均时间为9.75周，首次预约的中位等待时间从疫情前的19周减少到了3.6周。成本效益分析强调，尽管面对面咨询减少，但远程医疗诊所仍有能力降低间接费用并维持收入流。我们的研究得出结论，远程护理服务模式是管理新的LGI出血转诊患者的一种有效补充方法。有必要对长期结果和成本效益进行进一步研究，以全面评估远程护理作为一种潜在可持续的混合模式的情况。
